Expert: Dr. Randolph Myerson - 12/4/2009

Question
Hi there,

My 4.5 year old son as a decayed molar. This resulted in an abscess on the gum. He has no pain from this.  The dentist has tried pulp treatment in order to save the tooth, but this has not worked.

The dentist feels the best thing now is for the tooth to be extracted.  My son was relatively compliant for the pulp treatment (i.e. stayed in the chair and kept his mouth open), so the dentist hoped the extraction could be done under local anaesthetic.  He (and we) were keen to try this before we went down the general anaesthetic option route.  However, when this was tried today, my son was unhappy and basically kept his mouth shut, which meant no work could be done.

We are reluctant to have the general anaesthetic procedure unless it is absolutely necessary (it seems like quite a big thing for a small child, and we are aware that there is always a small element of risk involved).  As the abscess is not causing my son any pain, we are wondering what the pros and cons are of watching and waiting to see if the abscess will clear up on it's own, at least for a while - in the hope that my son may be able to handle the local procedure better later on?  Or is this unwise? Is it unlikely the infection would ever just clear up?  What are the possible adverse effects of leaving the tooth in with an ongoing abscess, even if it is not currently causing pain?  Do we really just need to bite the bullet and get on with the extraction using a general anaesthetic, or is watching and waiting for a while an option?  Our dentist said it was a difficult question, but that basically an ongoing infection was not a good thing.

Many thanks for your help.  

Answer
I shall repeat what you have already heard.  An ongoing, chronic infection is not a good thing.  First, the presence of an infection close to the developing permanent tooth can have a damaging affect on that tooth.  That is reason enough to not delay treatment.  Secondly, a chronic infection can quickly spread to the face and from there descend into the neck and/or ascend into the brain.  While these rarely occur they can have life-threatening consequences.  Delaying treatment is not without considerable risks.

In the US some pediatric dentists will attempt treatment in the office using sedation before they bring a youngster into the operating room for general anesthetic.  I don't know if that modality is available in the UK but it might be worth considering.